07100035 CIT� OF CUPERTINO � ' xT� it�
BUILDING DIVISION PERMIT U���1�������1 �Rkr,���T�N� : :
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PERMIT NO.
BUILD �N�g�pRss: DE ANZA BLVD BARRY SWENSON BUILDER 07100035 �
pERMIT LSSUE DATE
OWNER'S NAME:
BUNKER GREGG C 777 N FIRST ST 10/09/2007
SANiTARY NO. CONTROL NO.
.E:
(408)287-0246
BUILDING PERMiT INFO
ARCHiTECUENGINEER: B� E� PLU M�
i p � LICENSED CON7RACTOR'S DECLARATION JOb DeSCilptlOTl
; V� 1 hcrcby affirm that I am liccnscd undcr provisions of Chaptcr 9(commencing
; Z� with Scciion 70cw) of Division 3 of thc Business and Protcssiona C and my liccnsc is REV SN- AL D I T ' L DETA I L FOR C RO S S VENT I LTN
?�y infullforceandcfCect � # ` �� S' @MECHROCM/UPPER ROOF (ORIG #0705�023 )
� � ? Licensc Class
; �, O Datc Contractor
� RCH[TECI'S DECLAR N
j� a I undcrswnJ my plans shall lx uscd as public recorcls
)aU
� u. y Liccnsed Profcssional
� � a OWNER-BUILDER DECLARATiON
� a� 1 hcrcby aCfirm �hat I am ezcmpt from ihc Contractors Liccnx Law Car thc
p o following rcason. (Scction 7031.5, Busincss and Profcssions Ca1c: Any ciry or county
�°„ � which rcquires a pc�mit to conswct, altcr, improvc, dcmalish, or repair any structure
°" y prior to i�s issuancc, alsu requires �hc applicant for such permit �o filc a signcd statement S Ft. Floor Area Valuation
-�< �hat hc is liccnscd pursuant to thc provisions of thc ConUacwr's Li��cnsc law (C�wp�cr 9 q• � O
� E_- �(commcncing with Scction 7000) of Division 3 oC Ihc Business and Profcssians Codc) or
y�� that he is exempt thccefrom and ihe basis for �he allegcd exempUon. Any violauon of Occupancy Type
Section 7031.5 by arry applicant for a pertnit subjects the applicant to a civil penaity of 3 6 619 0 7]�°'(�� Number
noe more than f vc hundred dollars (SS00).
Q I, u owncr of ttie propecry. or my employca with wages as �heir so�c compensaGon.
will do �hc work, and ihe swctuce is notintended or ollered [or sale (Sa.704A. Business Required Inspections
and Professions Code: The Conuactor's License Law does nat aPP�Y ���W'"0� of
property who builds or improves thereon, and who does such wart himself or through 6is
own emplayces, provided tt�at such improvements are not intended or oRered far sale. lt.
however, the building or improvement is sold within one year of wmpleuon, the owner-
builder will have the burdu� o[ proving that he did nat build or improve tor pucpox of
sakJ.
Q 1, as owner of the propeny. am ezclusively conuacting with licensed rnnuxias a
constnut the projett (Sec. 7044. Business and Profcssions Cade:) Thc Conux�s Li-
ccnse Caw docs no� apply w an owner of propeny who buiids or improves the�eon, and .
who comracu for such projecls with a conuactar(s) licensed pursuant w U�e Conlractofs
License Law.
❑ 1 am exempt undu Sec. . B& P C far this reawn
Ownu Date _ .. -.
WORKER'S COMPENSATION DECLARATION
I hereby ��m under peaalty of pery'ury one o[ �he follawing declarations:
❑ I hsae and will maintain a Certifipte of Consen� to self-insure for Workeds Compen-
sation, as provided for by Section 3700 af the Labot Code, (nr the performance o[ We
woric for which this permit is issucd.
❑ I have and will maintain Worker's Compensadan lnsunnce. u required hy Scctian ,
3700 of thc Labor Codc. Cor tl�c perCormancc of Uu work for which this pertnit is issued
My Workers Compensation [nsurance carricr and Policy number arc:
Cartiu: Poliry No.:
C rcRTIFICs��� ....._... _.. ...
COMPENSATION 1NSURANCE
(This scction need not bc completed if the pecmit is far onc hundrcd dollars (5100) ,
or Icss.)
I cenify that in thc perfortnancc of thc work tor which ihis permit is issucd. I shatl na
employ any person in any manner so u to become wbject io the Workers' Compensation
Laws of Cali[omia. Datc
Applicant
NOTICE TO APPLICAM: If, af�cr making �his Ccrti[ica�c of Excmption, you should
bccome subjcct W ihc Workcr's Compcnsation provisions of Uic Labor Codc, yau must
� O forthwi�h comply with such provisions or lhis pccmi� shall bc dccmcd rcvokcd.
z ""' CONSTRUCTION LENDING AGENCY
[.�-� r�-i I hcreby alfirtn Ihat thcre is a coiuwcdnn lending agcrcy for thc perlormance uf -
�,' thc wurk for which �his permit is issucd (Scc. 3097. Civ. CJ ,
W Q Lendcr's Narnc
a z Lcnd�r's Address
V � 1 certifY ihat 1 havc rcad lhis application and s�a�c tha� �hc abovc inCormaliun is
cortcct. 1 agree to comply with all city and county onfinances and stak laws relating to
� U buildiag conswction, and hcrcby authori�e represcntativcs of �his ci�y to cntcr upon �hc
abovc-mcntioncd property (or inspcc�on purposes.
�'' a (Wc) agrce ro save, indcmnify and kecp harmlcss the City of Cupertino against
�� liabitiues, judgmen�s, cos�s and expcnscs which may in any way accnu against said City
(� z in consequcncc af thc granting of ihis permit. Dg[e
� APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT Issued by:
SOURCE REGULATIONS. � 1 �
�r} �� � '�_ �� ��1 �fl 7 Re-roofs
Signature of ApplicanUConuactor � 'T of R oof
HAZARDOUS MA7'ERIALS DISC[.OSURE YP
Wip ihc applicant or futurc building accupant storc or handic harardous matcriil
u defincd by thc Cupectino Municipal Codc. Chaptcr 9.12, and thc Hcal�h and Safe�y
CoJc, SccGon 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
�Ycs �No .
If a roof i� installed without first obtaining an inspection, I agree to remove
Will thc applicant or futurc building occupant usc eyuipmcm or devices which
emit harardous air contaminan�s as dcGncd by the Bay Arca Air Quality Managcment all new m aterials for inspection.
��su;��?
QYcs �No
1 havc rcad the hvarCcws maicrials requircmcn�s undcr Chap�cr 6.95 0( ihc Cali[oo-
nia Hcalth & Safcry Codc, Sections 25505.25533 and 25534.1 undcrs�and �ha� if ilu huilding
docs nol curtcnlly havc a Icnan[, �hat it is my rcspansiAility to noul'y lhc occupant nf 1he
rcyuircmcn�s which m c me w issuancc of a Ccnificatc of Occ , Signature of Applicant Date
�� !� �� Z�— All roof coverings to be Class "B" or better
Owncr or aulhorii.cd agcnl ���